Transition From Temporary to Durable Circulatory Support Systems.

Cardiopulmonary Resuscitation / methods Clinical Decision-Making / methods Europe / epidemiology Extracorporeal Membrane Oxygenation / instrumentation Female Heart-Assist Devices / statistics & numerical data Humans Male Middle Aged Mortality Patient Selection Prognosis Registries / statistics & numerical data Retrospective Studies Risk Factors Shock, Cardiogenic / physiopathology Survival Rate

extracorporeal life support extracorporeal membrane oxygenation mechanical circulatory support outcome predictors

Journal

Journal of the American College of Cardiology

ISSN: 1558-3597

Titre abrégé: J Am Coll Cardiol

Pays: United States

ID NLM: 8301365

Informations de publication

Date de publication:
22 12 2020

Historique:

received: 30 09 2020

accepted: 13 10 2020

entrez: 18 12 2020

pubmed: 19 12 2020

medline: 12 3 2021

Statut: ppublish

Résumé

The decision to implant durable mechanical circulatory systems (MCSs) in patients on extracorporeal life support (ECLS) is challenging due to expected poor outcomes in these patients. The aim of this study was to identify outcome predictors that may facilitate future patient selection and decision making. The Durable MCS after ECLS registry is a multicenter retrospective study that gathered data on consecutive patients who underwent MCS implantation after ECLS between January 2010 and August 2018 in 11 high-volume European centers. Several perioperative parameters were collected. The primary endpoint was survival at 1 year after durable MCS implantation. A total of 531 durable MCSs after ECLS were implanted during this period. The average patient age was 53 ± 12 years old. ECLS cannulation was peripheral in 87% of patients and 33% of the patients had history of cardiopulmonary resuscitation before ECLS implantation. The 30-day, 1-year, and 3-year actuarial survival rates were 77%, 53%, and 43%, respectively. The following predictors for 1-year outcome have been observed: age, female sex, lactate value, Model of End-Stage Liver Disease XI score, history of atrial fibrillation, redo surgery, and body mass index >30 kg/m The outcome in patients receiving durable MCS after ECLS remains limited, yet preoperative factors may allow differentiating futile patients from those with significant survival benefit.

Sections du résumé

BACKGROUND

The decision to implant durable mechanical circulatory systems (MCSs) in patients on extracorporeal life support (ECLS) is challenging due to expected poor outcomes in these patients.

OBJECTIVES

The aim of this study was to identify outcome predictors that may facilitate future patient selection and decision making.

METHODS

The Durable MCS after ECLS registry is a multicenter retrospective study that gathered data on consecutive patients who underwent MCS implantation after ECLS between January 2010 and August 2018 in 11 high-volume European centers. Several perioperative parameters were collected. The primary endpoint was survival at 1 year after durable MCS implantation.

RESULTS

A total of 531 durable MCSs after ECLS were implanted during this period. The average patient age was 53 ± 12 years old. ECLS cannulation was peripheral in 87% of patients and 33% of the patients had history of cardiopulmonary resuscitation before ECLS implantation. The 30-day, 1-year, and 3-year actuarial survival rates were 77%, 53%, and 43%, respectively. The following predictors for 1-year outcome have been observed: age, female sex, lactate value, Model of End-Stage Liver Disease XI score, history of atrial fibrillation, redo surgery, and body mass index >30 kg/m

CONCLUSIONS

The outcome in patients receiving durable MCS after ECLS remains limited, yet preoperative factors may allow differentiating futile patients from those with significant survival benefit.

Identifiants

DOI: 10.1016/j.jacc.2020.10.036 PMID: 33334424

pubmed: 33334424

pii: S0735-1097(20)37630-0

doi: 10.1016/j.jacc.2020.10.036

pii:

doi:

Types de publication

Journal Article Multicenter Study

Langues

eng

Sous-ensembles de citation

Pagination

2956-2964

Commentaires et corrections

Type : CommentIn

Informations de copyright

Déclaration de conflit d'intérêts

Author Disclosures The authors have reported that they have no relationships relevant to the contents of this paper to disclose.